Clinical usefulness of home blood pressure measurement in patients on chronic hemodialysis

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Chronic hemodialysis (n=106). Intervention: Home blood pressure measurement vs. Office blood pressure measurement. Primary outcome: Correlation between logarithmically converted BNP and systolic home blood pressure in the morning (r=0.249, p=0.0098).

Satoru Kuriyama; Yasushi Otsuka; Rinako Iida; Kei Matsumoto; Midori Suga; Soichi Sakai; Yoshihisa Ishikawa; T Ishikawa; Tatsuo Hosoya

doi:10.4009/jsdt.39.1511

January 1, 2006Nihon Toseki Igakkai ZasshiOpen Access

Clinical usefulness of home blood pressure measurement in patients on chronic hemodialysis

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Key result

Home blood pressure measurement in the morning correlated with BNP and ANP, whereas office blood pressure did not, suggesting it is a better predictor of cardiovascular risk in hemodialysis patients.

Why the study?

Does home blood pressure measurement better correlate with markers of left ventricular dysfunction (BNP) and volume overload (ANP) compared to office blood pressure in patients on chronic hemodialysis?

Key Points

To evaluate blood pressure control status and assess the predictive value of home blood pressure monitoring for subclinical heart disease and fluid overload in chronic hemodialysis patients.
Evaluated 106 patients with chronic renal failure undergoing maintenance hemodialysis.
Measured morning and evening home blood pressure (HBP) along with pre- and post-dialysis office blood pressure (OBP).
Correlated blood pressure parameters with circulating levels of brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP).
Morning systolic hypertension occurred in 81.1% of patients, with poorly controlled morning systolic pressure in 65.1%, masked hypertension in 16.0%, and white-coat hypertension in 9.4%.
Morning systolic HBP (150±23 mmHg) was significantly higher than evening systolic HBP (145±20 mmHg; p=0.0297), while office systolic pressure was 150±20 mmHg; diastolic pressures showed no differences across settings.
Circulating BNP correlated positively with morning (r=0.249, p=0.0098) and evening (r=0.266, p=0.0057) systolic HBP, while ANP correlated with morning systolic HBP (r=0.381, p=0.0112) and morning diastolic HBP (r=0.322, p=0.0346).

Study Design

Type

Cross-Sectional (n=106)

Multicenter

Yes

Structured PICO

Does home blood pressure measurement better correlate with markers of left ventricular dysfunction (BNP) and volume overload (ANP) compared to office blood pressure in patients on chronic hemodialysis?

P

Population

106 patients with chronic renal failure on long-term hemodialysis who recorded self-measured home blood pressure to evaluate blood pressure control and cardiovascular complications.

E

Exposure

Home blood pressure (HBP) measurement (morning and bedtime)

C

Comparator

Office blood pressure (OBP) measurement

O

Outcome

Correlation of HBP and OBP with plasma BNP and ANP concentrationssurrogate

Main Result

Effect estimate: r=0.249

p-value: p=0.0098

In hemodialysis patients, home blood pressure measurement reveals a high prevalence of poorly controlled hypertension and correlates better with BNP and ANP than office blood pressure, making it a useful predictor of cardiovascular risk and volume overload.

Limitations

Small sample size
Cross-sectional design limits causal inference
The study did not quantitatively identify the relationship between BNP and cardiac hypertrophy/heart failure or ANP and volume-related parameters from an etiological perspective

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Answers are grounded in this paper and cite their sources.

Implication

Supports home BP monitoring for CV risk assessment in hemodialysis; hypothesis-generating until confirmed prospectively.

Abstract

高血圧の診断・治療において家庭血圧 (home blood pressure: HBP) 測定の重要性が注目されている. 本研究では慢性腎不全で血液透析 (hemodialysis: HD) 中の患者106例においてHBPと外来血圧 (office blood pressure: OBP) の両者から血圧管理現況と, HBPの潜在的心疾患や体液量過剰に対する予知能について検討した. 1) HBP (朝) においては収縮期高血圧81.1%, 拡張期高血圧45.3%と早朝高血圧が高頻度にみられた. また, HBP (朝) を用いた収縮期血圧管理区分は, 管理良好群9.4%, 管理不良群65.1%, 仮面高血圧群16%, 白衣高血圧群9.4%と管理不良例が高頻度にみられた. HBP (夜) においても収縮期高血圧58.9%, 拡張期高血圧34.9%と高血圧が多数みられた. また, HBP (夜) を用いた収縮期血圧管理区分は, 管理良好群12.3%, 管理不良群55.7%, 仮面高血圧群13.2%, 白衣高血圧群18.9%と管理不良例が高頻度にみられた. 2) HBP (朝) の収縮期血圧 (150±23mmHg) はHBP (夜) (145±20mmHg) に比べて有意に高値であるが (p=0.0297 by Scheffe's method), OBPの収縮期血圧 (150±20mmHg) とは同等であった. 一方, HBP (朝), HBP (夜), OBPの拡張期血圧は三者間に差異はみられなかった. 3) BNPと収縮期血圧の正相関はHBP (朝) (r=0.249, P=0.0098) とHBP (夜) (r=0.266, p=0.0057) の両者でみられた. 一方, BNPはOBPの収縮期血圧とは関連性がなかった. また, BNPとHBP (朝), HBP (夜), OBPの拡張期血圧との間にはいずれも関連性がみられなかった. 4) ANPは, HBP (朝) の収縮期血圧 (r=0.381, p=0.0112) と拡張期血圧 (r=0.322, p=0.0346) いずれとも正相関した. また, 透析後のOBPは収縮期血圧 (r=0.521, p=0.0003) と拡張期血圧 (r=0.453, p=0.002) ともにANPと良好な相関関係を認めた. 一方, ANPはHD前のOBPとHBP (夜) 両者の収縮期血圧, 拡張期血圧のいずれとも関連性がみられなかった. 以上, HD患者はOBP, HBP両者において高頻度に高血圧がみられることから依然として心血管疾患など高血圧性合併症の大きなリスクを有していると思われた. また, HBPはBNPやANPと関連づけることにより潜在的心疾患や体液過剰の良好な予知因子となり, 高血圧の治療ターゲットとして有用である可能性が示唆された.

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Cite This Study

Kuriyama et al. (2006) conducted a cross-sectional in Chronic hemodialysis (n=106). Home blood pressure measurement vs. Office blood pressure measurement was evaluated on Correlation between logarithmically converted BNP and systolic home blood pressure in the morning (r=0.249, p=0.0098). Home blood pressure measurement in the morning correlated with BNP and ANP, whereas office blood pressure did not, suggesting it is a better predictor of cardiovascular risk in hemodialysis patients.

synapsesocial.com/papers/6a9f69424bb82c3c71b20d2a https://doi.org/10.4009/jsdt.39.1511

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Clinical usefulness of home blood pressure measurement in patients on chronic hemodialysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clinical usefulness of home blood pressure measurement in patients on chronic hemodialysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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